Medicare bilked of $120 million by illegals, felons

Illegal immigrants and prison inmates received more than $120 million in Medicare services from 2009-2011 despite federal law that makes them ineligible for the program, according to two new reports from the HHS inspector general.

The issue, according to the reports, is timing. When Medicare is alerted that someone is incarcerated or undocumented, its contractors help prevent payments from going out the door. But often, Medicare's databases aren't up to date, and improper payments go out.

And Medicare lacks the tools to get the money back.

Nearly 3,000 illegal immigrants made thousands of claims resulting in $91.6 million in services improperly covered by Medicare during the three-year period studied in the report.

Over the same period, more than 135,000 Medicare beneficiaries were incarcerated, a second report shows. The report says that 11,600 inmates submitted more than 75,000 claims and received services worth $33.6 million.

"CMS did not have policies and procedures to review incarceration information on a post-payment basis that would have detected improper payments that the prepayment edit could not prevent," according to the report.

In responses to the reports, CMS agreed to identify improper payments and find ways to try to get the money back in the future, but the agency stopped short of pledging to go after the money already improperly out the door.

Estimates on Medicare fraud are iffy. That's because the government has no way to measure it. One ballpark estimate is 3% of total Medicare expenditures - about $68 billion. But some experts scoff at that number as ridiculously low.

One thing is certain: Medicare is a ludicrously easy target for con men and thieves since so much of it is automated and inadequate procedures are in place to verify eligibility. Not only that, Medicare has no tools to go after the money even when they realize the fraud.

They've been trying to deal with Medicare fraud since the 1970's and have failed utterly. Time to use some hi tech tools to protect the taxpayer from the criminals who seek to defraud us, as well as a government too lazy to protect us.

Illegal immigrants and prison inmates received more than $120 million in Medicare services from 2009-2011 despite federal law that makes them ineligible for the program, according to two new reports from the HHS inspector general.

The issue, according to the reports, is timing. When Medicare is alerted that someone is incarcerated or undocumented, its contractors help prevent payments from going out the door. But often, Medicare's databases aren't up to date, and improper payments go out.

And Medicare lacks the tools to get the money back.

Nearly 3,000 illegal immigrants made thousands of claims resulting in $91.6 million in services improperly covered by Medicare during the three-year period studied in the report.

Over the same period, more than 135,000 Medicare beneficiaries were incarcerated, a second report shows. The report says that 11,600 inmates submitted more than 75,000 claims and received services worth $33.6 million.

"CMS did not have policies and procedures to review incarceration information on a post-payment basis that would have detected improper payments that the prepayment edit could not prevent," according to the report.

In responses to the reports, CMS agreed to identify improper payments and find ways to try to get the money back in the future, but the agency stopped short of pledging to go after the money already improperly out the door.

Estimates on Medicare fraud are iffy. That's because the government has no way to measure it. One ballpark estimate is 3% of total Medicare expenditures - about $68 billion. But some experts scoff at that number as ridiculously low.

One thing is certain: Medicare is a ludicrously easy target for con men and thieves since so much of it is automated and inadequate procedures are in place to verify eligibility. Not only that, Medicare has no tools to go after the money even when they realize the fraud.

They've been trying to deal with Medicare fraud since the 1970's and have failed utterly. Time to use some hi tech tools to protect the taxpayer from the criminals who seek to defraud us, as well as a government too lazy to protect us.